Psychiatric Mental Health Nursing by Videbeck

118 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP

Table 6-1

(Continued)

Therapeutic

Communication Technique Examples Rationale

Nurse says nothing but

continues to maintain eye

contact and conveys

interest.

“Perhaps you and I can

discuss and discover the

triggers for your anxiety.”

“Let’s go to your room, and

I’ll help you find what

your looking for.”

“Have I got this straight?”

“You’ve said that.. .”

“During the past hour, you

and I have discussed.. .”

Client:“I’m dead.”

Nurse:“Are you suggesting

that you feel lifeless?”

Client:“I’m way out in the

ocean.”

Nurse:“You seem to feel

lonely or deserted.”

Client:“I can’t talk to you or

anyone. It’s a waste of

time.” Nurse:“Do you

feel that no one under-

stands?”

“Isn’t that unusual?”

“Really?”

“That’s hard to believe.”

Silence often encourages the client to verbalize,

provided that it is interested and expectant.

Silence gives the client time to organize

thoughts, direct the topic of interaction, or

focus on issues that are most important.

Much nonverbal behavior takes place during

silence, and the nurse needs to be aware of

the client and his or her own nonverbal

behavior.

The nurse seeks to offer a relationship in which

the client can identify problems in living with

others, grow emotionally, and improve the

ability to form satisfactory relationships. The

nurse offers to do things with, rather than for,

the client.

Summarization seeks to bring out the important

points of the discussion and to increase the

awareness and understanding of both partici-

pants. It omits the irrelevant and organizes the

pertinent aspects of the interaction. It allows

both client and nurse to depart with the same

ideas and provides a sense of closure at the

completion of each discussion.

Often what the client says, when taken literally,

seems meaningless or far removed from reality.

To understand, the nurse must concentrate on

what the client might be feeling to express

himself or herself this way.

Putting into words what the client has implied

or said indirectly tends to make the discussion

less obscure. The nurse should be as direct

as possible without being unfeelingly blunt

or obtuse. The client may have difficulty

communicating directly. The nurse should take

care to express only what is fairly obvious;

otherwise the nurse may be jumping to

conclusions or interpreting the client’s

communication.

Another means of responding to distortions of

reality is to express doubt. Such expression

permits the client to become aware that others

do not necessarily perceive events in the same

way or draw the same conclusions. This does

not mean the client will alter his or her point of

view, but at least the nurse will encourage the

client to reconsider or reevaluate what has

happened. The nurse neither agreed nor dis-

agreed; however, he or she has not let the

misperceptions and distortions pass without

comment.

Adapted from Hayes, J. S., & Larsen, K. (1963). Interactions with patients.New York: Macmillan Press.

Silence—absence of verbal

communication, which

provides time for the

client to put thoughts or

feelings into words,

regain composure, or

continue talking

Suggesting collaboration—

offering to share, to strive,

to work with the client for

his or her benefit

Summarizing—organizing

and summing up that

which has gone before

Translating into feelings—

seeking to verbalize

client’s feelings that he

or she expresses only

indirectly

Verbalizing the implied—

voicing what the client

has hinted at or

suggested

Voicing doubt—expressing

uncertainty about the

reality of the client’s

perceptions